Provider Demographics
NPI:1821009374
Name:WEGENER, FREDERICK DEAN (M DIV, M S)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:DEAN
Last Name:WEGENER
Suffix:
Gender:M
Credentials:M DIV, M S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-6311
Mailing Address - Country:US
Mailing Address - Phone:253-752-9112
Mailing Address - Fax:
Practice Address - Street 1:1614 S MILDRED ST
Practice Address - Street 2:SUITE B
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1626
Practice Address - Country:US
Practice Address - Phone:253-564-4233
Practice Address - Fax:253-564-9451
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00000983106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist